Women in remote Pakistan ostracized for medical condition

By

Safiullah Shahwani

Women wait to see a doctor at DHQ hospital in Pakistan. Photo by Matiullah Achakzai/News Lens Pakistan

QUETTA, Pakistan, Sept. 23 (News Lens Pakistan) -- Ever since she endured a complicated pregnancy years ago, Bibi Razia has been ostracized by her family, barred from even sitting with her husband other members of her family.

She suffers from a little-known but devastating disease known as obstetric fistula. The condition, according to the Fistula Foundation, is the result of a hole between the vagina and rectum or bladder caused by prolonged labor and often affects women in the developing world due to the poor state of maternal care there.

"I was abandoned in a separate room with my child, and food was served me there," Razia said. "I was not allowed to cook food because of the smell that continuously came from me."

In Pakistan, there are said to be as many as 8,000 fistula cases. The large number of cases is blamed on women in places like Balochistan province having babies delivered at home by traditional birth attendants because they cannot afford to go to the hospital. Botched hysterectomies are responsible for causing fistula.

"This is a disease of poor, where poor women grapple with it during the delivery," said Sajjad Siqqui, the Pakistan country director for the U.N. Population Fund, adding that among every 100,000 delivery cases, 726 women die each year in Pakistan, and the ones who survive suffer complications of fistula."

Siqqui said that there are only 56 doctors in the entire country available to treat fistula patients, partly because it is not a lucrative business.

"In Balochistan, only four doctors have expertise to treat patients, all based in Quetta," Siqqui added.

Ahsan Tabusum, the U.N. agency's provincial coordinator, told News Lens Pakistan that the agency, in collaboration with the Pakistan National Forum for Women Health, has opened three centers for fistula treatment in Quetta. They have treated over 500 patients since 2006, he said, with a 90 percent success rate. But he said so far there has been little interest from the government in expanding or taking over the program. Making matters worse, doctors at government facilities often fail to refer patients or
inform the women of the centers.

"Once we roll back our program, then what will be the fate of patients suffering from fistula?" Tabusum wondered.

Adding to the women's woes is the fact that many are given little support and wait years and even decades to have the condition addressed. Most do not even know there is a relatively routine treatment available, and are often abandoned by their families before they get the treatment.

"We do not have recorded data as to how many women have been divorced in Balochistan or abandoned so far, but I do have idea that they are beaten, abandoned and even divorced after developing fistula," said Tasneem Ashraf, president of Pakistan Association of Gynecologists.

The obstetric fistula can be closed with intravaginal surgery, according to the Fistula Foundation. If a skilled surgeon performs the surgery, the foundation said a fistula patient has a good chance of
returning to a normal life.

Women who do not know about the treatment are forced to endure a life of misery.

One of those women, Bibi Sursan, has been suffering with the condition for 25 years. Living in the remote district of Harnai, Sursan only learned about the condition when she visited a doctor in Quetta.

"I informed my husband, but he did not know that the disease would linger on for the next three decades," said Sursan, who is in the process of getting treatment.

Razia, too, has come to Quetta for treatment.

Hailing from Nasirabad district, 125 miles from the Quetta, Razia could not afford to get the treatment for much of her life because her husband is a poor farmer. After finally making the travel arrangements to Quetta, however, she was found to have developed an infection in her bladder.

"I was abandoned and ostracized," she said. But with the treatment, Razia said she is hopeful her life can change for the better.